Prior Authorization Burden: 7 Daily Challenges US Doctors Face
·15 min read
Key Takeaways
US practices complete about 39 prior authorizations per physician every week, and the work eats roughly 13 hours of physician and staff time.
In the AMA's 2025 survey, 93% of physicians said prior authorization delays care at least some of the time, and more than 1 in 4 linked it to a serious adverse event.
Prior authorization, EHR documentation, and after-hours inbox work are not three separate problems. Each one feeds the next.
Since January 1, 2026, Medicare Advantage, Medicaid, and CHIP plans must answer urgent requests within 72 hours and standard ones within 7 calendar days.
Only 33% of physicians believe the June 2025 insurer pledge will make a meaningful difference.
Thirty-nine. That is how many prior authorization requests the average US practice now files for each physician, every single week, according to the American Medical Association's 2025 survey. Most of those requests are for care the doctor has already decided the patient needs.
The prior authorization burden is only one part of the paperwork squeeze. Behind it sits a growing EHR documentation load and an inbox that follows physicians home at night. This guide breaks down the seven daily challenges these pressures create, shows how they connect, and explains which 2026 rule changes may actually help.
Why Paperwork Now Shapes a US Physician's Day
Ask a physician what fills the week, and the answer is rarely "patients." AMA data for 2023 put the average physician workweek at 59 hours. Only 27.3 of those hours went to direct patient care. Another 14.1 went to indirect care such as orders and chart review, and 7.9 hours went to pure administrative work.
Put simply, less than half of a doctor's working time is spent with patients. The rest is the paperwork that surrounds the care.
That administrative burden for physicians comes from three main sources:
Prior authorization, where an insurer must approve a test, drug, or procedure before it happens.
Documentation, the clinical notes, orders, and coding that live in the electronic health record (EHR).
Inbox work, the patient portal messages, refill requests, and results that arrive all day and all night.
Hospital leaders feel the same squeeze from the other side of the desk, as our breakdown of the challenges healthcare administrators face shows. Here, the focus stays on the physician.
The Prior Authorization Burden: 7 Daily Challenges US Doctors Face
The data below comes mainly from the 2025 AMA Prior Authorization Physician Survey, which polled 1,000 practicing physicians in December 2025 and was published in May 2026. Other sources are named where they appear.
1. How Much Time Do Doctors Spend on Prior Authorization?
According to the AMA's 2025 survey, the weekly prior authorization workload for one physician looks like this:
39 requests per physician, per week
13 hours of combined physician and staff time to process them
40% of physicians have staff who work only on prior authorization
Here is what that means for a small practice. A three-physician family medicine office would file about 117 requests a week and spend around 39 hours handling them. That is almost one full-time employee doing nothing but insurer paperwork. Over a year, the 13 weekly hours add up to roughly 676 hours per physician.
A typical practice handles about 39 prior authorization requests per physician each week.
2. Delayed and Abandoned Care
The time cost hurts staff. The care cost hurts patients. In the same AMA survey, 93% of physicians said prior authorization delays care at least some of the time, and 82% said it can push patients to give up on a treatment plan.
The outcomes can be serious. More than 1 in 4 physicians reported that prior authorization led to a serious adverse event for one of their patients, and 23% said it led to a hospitalization. Overall, 94% described its effect on patient outcomes as somewhat or significantly negative.
A delay is not just an inconvenience. When a patient waits days for an approved medication, some never fill it at all, and the condition the drug was meant to control keeps getting worse.
3. Denials Built on Criteria Doctors Do Not Trust
Physicians do not just dislike the volume. Many question the rules behind it. About 31% of physicians in the AMA survey said prior authorization criteria are rarely or never evidence-based.
Denials are also climbing. One in five physicians said their requests are often or always denied, and 75% said the number of denials has risen over the past five years. Each denial restarts the cycle: a peer-to-peer call, an appeal letter, and another wait.
4. Appeals Reviewed by the Wrong Specialist
When an insurer denies care as not medically necessary, physicians expect the decision to come from a clinician who understands the case. The June 2025 insurer pledge promised exactly that. Yet only 24% of physicians in the AMA survey said denials are consistently reviewed by an appropriately qualified clinician.
For a cardiologist, losing a peer-to-peer call to a reviewer from an unrelated specialty is one of the most frustrating moments of the week. It also wastes time that could have gone to patients.
5. The Documentation Burden Inside the EHR
The documentation burden is the second weight on the scale. A 2024 study in the Annals of Family Medicine tracked 141 primary care physicians at UW Health from May 2019 to March 2023. For every 8 hours of scheduled clinic time, their EHR time rose from about 364 minutes to about 392 minutes.
Read that number again. For every 8-hour clinic day, these doctors logged roughly 6.5 hours inside the EHR. Order entry grew fastest, up 58.9% over the study period.
New tools are starting to chip away at note writing. Our review of what the data shows on AI scribes covers how much time ambient documentation really saves.
6. The Inbox and Pajama Time
Pajama time is the EHR and inbox work physicians finish at home, after clinic hours, often late in the evening. It covers notes, patient messages, refill requests, test results, and prior authorization paperwork that did not fit into the workday.
The AMA found that 20.9% of physicians spent more than 8 hours a week on the EHR outside normal working hours in 2023, the same share as in 2022. That is a full extra workday, done after dinner.
Inbox volume is a big driver. In the Annals of Family Medicine study, inbox time per 8 scheduled hours climbed 24.4%, and patient medical advice requests rose 55.5% compared with pre-pandemic levels. The authors also noted that physicians in the United States receive nearly three times as many inbox messages as physicians in other countries.
About 1 in 5 US physicians spends more than 8 hours a week on the EHR outside normal working hours.
7. The Burnout That Follows
The first six challenges end in the seventh. According to the AMA's Organizational Biopsy, which gathered close to 19,000 physician responses from 106 health systems, 41.9% of US physicians reported at least one symptom of burnout in 2025. That is down from 43.2% in 2024 and 48.2% in 2023, so the trend is improving.
Still, roughly 4 in 10 doctors are burned out, and 32% said they plan to leave their organization within two years. Among the leading physician burnout causes, paperwork tops the list. Medscape's 2024 Physician Burnout and Depression Report, based on 9,226 physicians, found that 62% of burned-out doctors named too many bureaucratic tasks, such as charting and paperwork, as a cause.
Burnout is not spread evenly. Here is how selected specialties compared in the AMA's 2025 data:
Specialty
Burnout Rate (2025)
Emergency medicine
49.8%
Urological surgery
49.5%
Hematology and oncology
49.3%
Obstetrics and gynecology
45.7%
Radiology
45.2%
Family medicine
45.0%
Psychiatry
31.6%
Dermatology
31.5%
Nephrology
29.3%
Infectious diseases
23.3%
Several of the hardest-hit fields, such as family medicine and emergency medicine, are also among the specialties facing the biggest shortages. When burned-out physicians cut hours or leave, the remaining doctors absorb the extra work.
Why Do Insurers Require Prior Authorization?
To be fair to insurers, prior authorization has a real purpose. Health plans use it to check that an expensive test, drug, or procedure matches clinical guidelines before they pay for it. The goal is to cut waste, steer patients toward safer or lower-cost options, and catch care that is unlikely to help.
The problem is not the idea. It is the scale and the friction. When nearly 40 requests a week land on each physician, many of them for routine care that is almost always approved, the check stops working as a safety net and becomes a toll booth.
The fairest reading of the data: prior authorization may make sense for a narrow set of high-cost, high-variation services. Applied broadly, it costs more time than it saves.
How the Three Pressures Feed Each Other
Most articles treat prior authorization, documentation, and burnout as separate topics. In a real clinic, they form a chain:
1. A prior authorization request needs supporting notes, so the physician documents more detail in the EHR.
2. A denial or a request for more information lands in the inbox, often mid-afternoon when the schedule is full.
3. The unfinished inbox goes home, adding to pajama time.
4. Lost evenings and weekends wear down recovery time, which raises burnout risk.
5. Burned-out physicians cut hours or leave, which shifts more paperwork onto the colleagues who stay.
This is why physician burnout causes are so hard to untangle, and why fixing one link alone rarely works. An AI scribe can shorten notes, but it does not stop a denial. A faster insurer response helps, but not if the reply still lands in an overflowing inbox at 9 p.m. Lasting relief needs action on all three.
What Is Changing for Prior Authorization in 2026
For the first time in years, several real changes are landing at once. Here is a quick timeline of the biggest ones:
Date
Change
Who It Covers
June 2025
Voluntary insurer pledge to simplify prior authorization
Dozens of health plans, including UnitedHealthcare, Aetna, and Cigna
January 1, 2026
72-hour urgent and 7-day standard decision deadlines, plus specific denial reasons
Medicare Advantage, Medicaid, and CHIP plans
January 1, 2026
WISeR prior authorization model begins
Traditional Medicare in 6 states
January 1, 2026
New plans honor existing approvals for 90 days when a patient switches insurers
Pledge participants
January 1, 2027
Electronic prior authorization APIs required
Plans covered by CMS-0057-F
Key prior authorization deadlines for US practices in 2026 and 2027.
The CMS Prior Authorization Rule (CMS-0057-F)
The CMS prior authorization rule, finalized on January 17, 2024, is the most important federal change for practices. According to the CMS fact sheet on CMS-0057-F, its first requirements took effect on January 1, 2026:
Urgent requests must get a decision within 72 hours.
Standard requests must get a decision within 7 calendar days.
Every denial must include a specific reason.
The rule applies to Medicare Advantage plans, Medicaid and CHIP programs and their managed care plans, and plans sold on the federal exchanges, although the exchange plans are exempt from the decision deadlines. Employer-sponsored commercial plans are not on the list. By January 1, 2027, covered plans must also offer a prior authorization API that lets EHRs request approval electronically using the HL7 FHIR standard.
Under the CMS prior authorization rule for 2026, the clock is now on the insurer's side of the desk. That alone will not cut request volume, but it should shorten the wait for patients.
Medicare's WISeR Model
Traditional Medicare is moving in the opposite direction. The WISeR model, which runs from January 1, 2026, through December 31, 2031, adds prior authorization for selected services in New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington.
Targeted services include skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy for knee osteoarthritis. Providers can choose to request prior authorization or accept a medical review after the service but before payment. Physicians with a strong approval record can qualify for a gold-card exemption. Researchers at Georgetown University's Center on Health Insurance Reforms have raised concerns about the model's use of artificial intelligence in reviews.
The Insurer Pledge: Promise vs Reality
In June 2025, dozens of health plans made voluntary commitments, together with HHS and CMS, to streamline prior authorization. Insurers and doctors tell very different stories about how it is going:
What Insurers Report (AHIP)
What Physicians Report (AMA)
11% fewer prior authorizations, about 6.5 million fewer requests
Practices still file 39 requests per physician each week
More than 15% fewer requests in Medicare Advantage
75% say denials have increased over five years
Medical necessity denials reviewed by qualified clinicians
Only 24% say that consistently happens
80% of electronic approvals answered in real time by 2027
Only 33% expect the pledge to make a meaningful difference
Both sets of numbers can be true at once. A cut of 11% is real progress, but it barely dents the weekly pile at the practice level. Physicians will judge the pledge by their own Monday morning queue, not by national totals.
Gold-Card Exemptions
Gold carding exempts physicians with high approval rates from prior authorization for certain services. Texas was an early adopter, and states including Louisiana and West Virginia also have gold-card laws. Several other states have bills pending, and the AMA tracks state prior authorization laws on its website.
If you practice in a gold-card state, check with your state medical society whether you qualify.
Practical Steps Physicians and Practices Can Take Now
Rules move slowly. These steps can lower the administrative burden for physicians today:
Moving routine prior authorization and inbox tasks to trained staff frees physician time.
1. Use payer portals and electronic prior authorization wherever plans offer them, and ask your EHR vendor about its CMS-0057-F API roadmap for 2027.
2. Track every denial by payer, service, and reason. Patterns turn into appeal templates and evidence for payer contract talks.
3. Hold insurers to the clock. For Medicare Advantage and Medicaid patients, note the request date and escalate when a decision passes 72 hours or 7 days.
4. Check gold-card eligibility under your state law and under WISeR if you practice in one of the six model states.
5. Move inbox work off the physician. Route refills, forms, and routine results to trained staff with clear protocols.
6. Protect inbox time inside the schedule so messages are cleared during the day, not after dinner.
Paperwork. In Medscape's 2024 report, 62% of burned-out physicians blamed too many bureaucratic tasks, such as charting and paperwork. That was well ahead of long hours and lack of respect at work.
According to AMA data, 41.9% of US physicians reported at least one burnout symptom in 2025. That is the third straight yearly drop, down from 48.2% in 2023.
Physicians say it often does. In the AMA's 2025 survey, 93% reported care delays, 82% said patients sometimes abandon treatment, and more than 1 in 4 linked prior authorization to a serious adverse event.
Gold carding exempts physicians with consistently high approval rates from prior authorization for certain services. Some states, including Texas, have gold-card laws, and Medicare's WISeR model offers a similar exemption.
No. The 72-hour and 7-day deadlines apply to Medicare Advantage, Medicaid, and CHIP plans. Employer-sponsored commercial plans are not covered by CMS-0057-F.
Where Physicians Go From Here
The prior authorization burden, the documentation load, and burnout are one connected problem. Thirty-nine requests a week create notes and messages; those messages spill into the evening, and the lost evenings wear doctors down.
There is real movement in 2026. Federal decision deadlines, the insurer pledge, and gold-card laws all point in the right direction. Physicians remain skeptical, though, and the data shows why. Until the weekly pile shrinks at the practice level, the most useful moves are local ones: tracking denials, holding plans to the new deadlines, and keeping inbox work out of the evening.
The paperwork will not vanish this year. It can get smaller, one workflow at a time.
Which part of the paperwork costs your practice the most time: prior authorization, notes, or the inbox? Share your experience in the comments, and pass this guide to a colleague who is still answering messages at midnight.
Published by Certify Me USA
Certify Me USA Editorial Team
Certify Me USA is a US-focused resource covering healthcare practice, workplace safety, and professional certification. This guide is based on analysis of official CMS rules, AMA physician survey data, AHIP industry reports, and peer-reviewed research, so American physicians and practice teams can act on verified facts.
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